PHANG POH HUI

Abstract

During our one-month long attachment at the National Neuroscience Institute @ SGH campus, we were tasked to craft a survey to collect data from Parkinson’s disease patients and caregivers regarding patient care and their experience at the clinic. After the collection of data, we analysed the data and proposed solutions to the problems and concerns the interviewees raised. Through this, we have gained a better understanding on the patients' and caregivers’ perception of the quality of care provided, how the outpatient clinic is run and gained more knowledge on Parkinson’s disease and other movement disorders. We also honed our communication and observation skills in the process and learnt many other things that made this journey an enriching and eye-opening one.

Background information of tasks we were involved in

Through this WOW! Attachment, we have acquired basic knowledge of Parkinson’s disease and other neurological conditions, experienced how neurology outpatient clinics are run, shadowed the clinical trial coordinator(s) in their day-to-day job flow and experienced basic-translational research lab activities.

At NNI itself, we were tasked to craft a survey regarding the quality of care provided to Parkinson’s disease patients. This was to collect feedback on patient satisfaction as well as to serve as a preamble and an indicator of how effective the various projects that the hospital are planning to roll out would be for the patients. This would ultimately improve the quality of the patient-centred care provided and bring quality life and better health to those they serve. This is especially important for Parkinson’s disease patients as Parkinson’s disease is a chronic condition with no cure and requires the patient to visit the hospital multiple times for follow-ups. Thus, improving the quality of care provided at the hospital can greatly improve their overall recovery and health.

To do so, we began by sitting in during Prof Tan’s consultations to understand more about the condition itself while also observing the way the clinic is run. We also picked out possible areas of improvement in the way care was provided. We noted the way the patient talks about something that could hint that they were not very satisfied with it. Then, we looked up similar patient satisfaction surveys and used them as reference to start the crafting of questions. We also added in new questions on our own that were more relevant to the upcoming projects that the hospital had. Our mentors gave us feedback and we made changes to the questions to make the survey more effective. We then set out to collect data by interviewing patients with Parkinson’s disease as well as their caregivers and family members. After data collection, we analysed the results and compared between the patient and non-patient responses to pick out trends. Lastly, we proposed solutions to the issues raised.

Elaboration/record of the activities done

We began by sitting in during Prof Tan’s consultations. We observed the way the clinic was run, from how the patient registered, to the calling of their queue number, their interaction with Prof Tan and the clinic assistant, and finally the billing of the medical fees. This was to give us a general idea on how an out-patient clinic is run and what the current system is like. We then had to “read between the lines” and look out for the things that are good, but can be improved to bring up the efficiency and the quality of care provided. By listening into the conversation between Prof Tan and the patients, we also gained a better understanding on the condition itself, the problems that the patient’s face and the doctor’s views. We also noted the tone and the way patients phrase certain things that could imply their unhappiness towards a certain aspect of the care provided. The clinic observations built up our understanding of the situation and gave us possible questions to ask to target the problems faced by the patients. Though the medical jargon was slightly challenging in the beginning, we managed to look up the words and better understand the consultations.

We then began crafting the survey after a few days of clinic observation. We referenced the current patient feedback form available in SGH as well as other patient satisfaction surveys online from different countries. We phrased the questions to get more responses on how the patients feel about the common issues that we picked out from our observations. We also added questions regarding the upcoming projects that were going to be rolled out to gather the patient’s perception, thoughts and concerns. With input from our mentors, we also changed certain questions and the way we phrased them to prevent bias. Finally, we translated the questions and options into Chinese to facilitate the data collection process later on.

After the survey was done, we used the crafted survey to interview Parkinson’s disease patients as well as their caregivers and family members. Through this, we were able to collect valuable feedback and their thoughts on what was good and other aspects that needed to be worked on. We also interviewed them in the language that they were more familiar with, since most elderly people are more familiar with Chinese and are less proficient in English, to seem more friendly and relatable to them, without alienating them by speaking in a “foreign” language. This also built more trust and rapport between us and the interviewees, making them feel more comfortable to share their deep concerns and what they genuinely felt with us.

Data analysis was carried out after we finished collecting the data. We picked out the common issues that most patients raised and noted that we should propose solutions to tackle these problems. We also went on to compare the responses of patients and non-patients (caregivers and family members) to spot trends. This would then allow us to strike a balance between what the patients and non-patients want to optimise during the hospital visit for both sides. This entire process also allowed us to better understand their concerns and suggestions which aided in the proposal of solutions later.

Finally, we brainstormed and came up with possible solutions to tackle the problems present in the system. Many of the problems faced were recurring such as the waiting times which are unavoidable. Thus, it was challenging and difficult to come up with novel solutions. We had to think out of the box to come up with creative yet feasible solutions.

In addition to our main task of the patient satisfaction survey, we also had the chance to visit the research labs. We observed the making of fly food for the drosophila flies that were genetically modified to exhibit similar symptoms of Parkinson’s disease. We also watched the separation of neutrophils and monocytes from blood samples using the concept of negative selection. Antibodies and a magnetic solution were added to the blood sample to make the unwanted cells magnetic. The unwanted cells would then stick to the side of the tube when placed in magnets. The process was then repeated to obtain only the wanted cells. We also interacted with the researchers there and understood more about their researches and the reason behind it.

Elaboration/record of results/impact of work done

Survey Results and Analysis

From our survey, we found the following:

Regarding waiting time, no patients waited more than 2 hours normally. However, the majority still had to wait for between 30 minutes to 2 hours. Waiting time was a major complaint. This is a major concern as patients that wait longer usually become more irritated and unhappy. Furthermore, the waiting time in our survey does not include the waiting time at the pharmacy, which also takes very long. Some patients or caregivers may only be taking half day leave for the consultation so time is very tight for them. The delays in the appointment time and the long waiting time is thus a huge problem that needs to be tackled.

Most patients found that well-explained treatments and an overview of the illness is the most important thing during the consultation. From this, we can infer that the majority of the patients would like to have a deeper understanding of their illness. A large number of patients also valued the doctor’s respect and care, which shows that the doctor’s attitude during consultation plays a very big part in terms of patient satisfaction.

One patient specially requested for the doctor to pay more attention to the patient, instead of looking at the computer. From this, we can infer that patients would like more eye contact from the doctor. Another also highlighted the importance of involving the caregiver, ensuring that the caregiver also participates actively during discussions so that the caregiver is able to better care for the patient.

Majority of patients would like more information on the illness and financial assistance. Many of the respondents would prefer the information to be available in the digital form since that would be more convenient and easier to access. This would then allow the patient and family members to mentally prepare for what to expect. A caregiver pointed out that although she was aware of the pamphlets that were available, she would have preferred if there was someone to prompt her or give her the pamphlet instead of assuming that every patient would be able to “self-help”. This also makes it easier for them to ask questions and clarify their doubts later. Many of the respondents also replied that they need some financial assistance. A large majority of the patients are elders aged 60 and above. Thus, the cost of the treatment and medication is very expensive to them since they are less financially able and do not generate much income. Furthermore, since there is no cure to Parkinson’s Disease, there is only medication provided to alleviate the symptoms. The list of medicine that the patient has to take is very long as each medicine has its different side effects which have to be countered by other medications. Hence, the number of types of medicine and the duration that the patients have to take the medicine for makes their medical bills very costly and a big burden for the patient. Thus, more help in terms of the financial side of things can be provided especially for patients with caregivers that are also old.

Most patients try to adhere to the doctor’s orders and recommendations for therapy and treatment. This shows that their self-enforced treatment will still be rather effective. However, it was also highlighted that some patients are unable to follow certain orders due to the nature of their illness. For example, some patients are unable to move or think clearly during their “off” periods. During these periods, it becomes nearly impossible for them to try to follow the doctor’s recommendations of trying to stay happy and exercise more. These patients will require more assistance to ensure that the doctor’s orders are followed.

The majority of the patients were mostly clear about the symptoms and health problems to look out for regarding their illness. However, many of the patients were unaware of pamphlets around which could provide them with the accurate and precise information that they needed. Many were also unaware of digital platforms that they could turn to: health buddy etc. This results in many patients requesting more information on the illness. Understanding their illness is a step nearer to the patients having a better understanding on how they may care better for themselves, reducing the number of consultation appointments being made.

There are varying levels of independence that the patients have in terms of caring for their illness. For patients with more severe PD and are not so independent in taking care of themselves, the Community Care Project would most likely benefit them more as the nurse can check in with them more frequently to ensure that their condition is still stable and to help with any other things if necessary. For patients that are more independent, the nurse check ups can be less frequent but they can possibly be a defence line to prevent the deterioration of the condition and to ensure that the patient is doing well.

The majority of the patients were able to navigate their way around the hospital without any assistance from the staff, leaving positive feedback about the large font size of the signage around the hospital. However, many patients have commented that the routes were getting a little confusing with the construction work going on around the hospital area. That said, many patients still had faith that things would get better when everything was restored after the construction work was completed. Some patients also recommended adding directions in Chinese. This would benefit the older patients who are only able to read Chinese. On the other hand, there were many complaints about parking, and distance of the clinic from the car park. Many patients commented that the car parks that they had parked at were very far away from the clinic and was very inconvenient. This revealed that many patients were unaware of car parks nearer to the clinic (E.g. OCH). When questioned, many patients were also worried that they would be unable to find their way to the clinic if they were to park at another car park.

The majority of the respondents would prefer to receive their required care at the same location, on the same day. Many commented that this would be more convenient, especially for patients with movement disorders, as they would not have to travel from one clinic to another. The majority of the respondents also felt that this would be a highly feasible scheme if waiting time between the appointments could be kept under 60 minutes. However, some also felt like this scheme would be ineffective as they thought that a whole day of treatments would be too tiring for them, especially for patients with more severe symptoms. To ensure the effectiveness of this scheme, much work still has to be done to ensure shorter waiting times between the different appointments. Location and space will also be another major problem if the different disciplines were to work together in the same area.

When we compared the responses between the patient group and non-patient group, we found that more patients would not prefer a one-stop integrated care centre as compared to non-patients. This could be because the patients understand their condition better and feel that this arrangement could be too tiring for some of them. A larger number of non-patients preferred a one-stop integrated care centre as compared to patients. This might be due to the fact that this will be more convenient to non-patients as they will not have to assist the patients in moving around. As most non-patients are the family members or caregivers of the patients, most of them need to take leave from work to accompany the patient to go for consultation. Thus, the one-stop integrated care centre is much more convenient for them as they will be able to take less leave while still accompanying patients to their consultation as well as take part in the therapy sessions. The non-patients can then go on to reinforce the techniques and exercises learnt during the therapy sessions better since they are able to accompany the patient for the session.

The majority of the patients had no one to turn to in the community regarding their condition. This shows that the care provided for Parkinson’s disease patients is still insufficient and more work needs to be done. We hope that through the Community Care Project, Parkinson’s disease patients will have someone to turn to in the community in the future.

Majority of the patients thought that the Community Care Program would be useful to their illness as the checkup would ensure that the dose of the medication is still suitable and effective and that the condition of the patient is not deteriorating. However, some claimed that their illness was already stable and that visits by the nurses would not change anything. Others feedback that it is difficult to accomplish this due as this would require more appointments to be made and problems such as being not home during the appointment and being uncomfortable with a stranger at home may arise.

We also referenced to patient experience surveys for patients with chronic diseases to look for possible issues to work on. We found that the main focus of patient experience in the different countries were mainly to reduce the waiting time and improving the quality of care provided.

To facilitate and improve patient experience, many countries have come up with care schemes targeted at patients with chronic diseases. For example, Sweden and Denmark are moving towards a more community-based support system. The UK has an Expert Patient Program where they hold sharing sessions for patients with the condition to share their experience. Japan also has something similar known as the Ikoino saron (recreation salon) where older people gather and interact through educational social programs. China has a Happy Life Club that trains doctors and nurses to change the behaviour of chronic disease patients by using motivational interviewing techniques. All these provide us with possible solutions we can take to improve care for Parkinson’s disease patients in Singapore.

When we compare the different members involved in the care team, we can see that there is an increasing trend in the involvement of the nurse to provide community support. There has also been more support groups led by patients with similar conditions. The sharing of the first-hand experiences that the patients had may be more useful and relevant to the patients, which may give them valuable insights to manage their condition better.

However, the amount of involvement of the caregivers in the process of recovery of the patient is very minimal.This could be a possible point to work on since caregivers are the ones that spend the most time with the patient, hence they can reinforce the things that are useful to the patient.

Proposed Solutions

After consolidating Parkinson’s disease patients’ needs and suggestions, we have identified the main problems to be: long waiting times, unawareness of possible tools and facilities that could improve their experience and a lack of information on their illness.

To these, we proposed the following solutions:

Other features of wristband include:

• Adjustable strap to fit any wrist size
• Large LED screen to ensure that older patients with eyesight problems are also able to read
• Linked to system, can be updated regularly
• Audio capabilities (alarm)
• Waterproof

As this solution might be slightly costly, the supply of wristbands may not be sufficient, hence we propose using the wristbands only when the estimated waiting time exceeds 45 minutes.

To ensure that the wristbands are returned, each wristband will be assigned a number that has to be keyed in and linked to a patient’s records upon registration. This will allow for accountability should the wristband be misplaced. The wristwatch will be returned upon payment. For efficiency, the wristwatch can be dispatched through the self-registration kiosk.

If needed, the wristband can also be programmed to vibrate when consultation slots are almost over. Again, this can be specially carried out when the clinic is very crowded. This will serve as a reminder for patients to respect the consultation time slots and quickly wrap up their consultation with the doctor. A similar reminder can also be given to the doctor to signal the end of the consultation.

Some patients have more severe illnesses than the others and will get restless and frustrated more easily. This also applies to patients who are not on their medications or are on their “off” periods. These patients should be given medical attention first due to their inability to wait for extended periods of time.

To ensure that this does not create a loophole in the system, these prioritised patients have to be certified by the doctor. Only with official confirmation from the doctors can the patients be given a priority queue.

The clinic assistant in the consultation room could be provided a computer with access to the doctor’s schedule and available appointment slots. This way, the clinic assistant is able to make an appointment in the consultation room itself instead of writing “Next doctor’s appointment in 6 months” and the patient has to wait at the counter to make their next appointment. The patient can then directly make payment at the counter or choose to pay via digital means, thus saving them from more waiting time.

To decrease the time taken for payment, we propose that we can have an auto generated QR code for the tax invoice at the end of the consultation. The patient can then scan the QR code and pay online directly instead of having to wait for their turn at the counter to pay. This also allows the patient to immediately leave the clinic and head to the pharmacy to pick up their medication without having to spend more time waiting unnecessarily.

When it comes to the collection of medicine, one problem that causes the long waiting time is that the pharmacist has to ask the patients how many months worth of medicine do they want to collect. Thus, we propose that the patients put an online order for the medication and indicate directly how many months worth of medicine they want to collect. The queue number for the collection of medicine at the pharmacy can also be issued as soon as the patient places their order. With this system, it would increase the efficiency of processing the orders and ultimately reduce the time the patient spends in the hospital.

2. To create a new front for SingHealth mobile application

The SingHealth mobile application, Health Buddy, first featured in 2013, failed the high expectations of many users as the application was inefficient, too complicated for old users, and troublesome (a SingPass authentication is needed each time a user logs in). As a result, many Singaporeans have chosen not to use the application.

Hence, we propose that more publicity can be done on the application, to increase public awareness. This can be done by:

• Social media publicising
• Television commercials
• Eye-catching posters around hospitals and polyclinics

While such an application has security concerns, the SingPass login with the mobile OTP, although troublesome, is already an improvement from needing to use the SingPass device for every login previously, and continues to ensure the safety of the user’s data.

However, this security measure also means that caregivers are unable to use the application to manage appointments on the patient’s behalf. This would deeply inconvenience many old patients. As such we propose the following:

Each patient can officially register for one caregiver. With official consent of both parties, the caregiver will be able to manage appointments on behalf of the patient for one month. One month later, the caregiver will have to re-register to ensure that third party organisations do not make use of this loophole to earn money.

Another improvement that can be made to the application is to provide medication reminders. Many patients have an overwhelming number of medication to take and different doses of each medication have to be taken at different times of the day. The reminders should be entered by the pharmacy, but can be customised at the patient’s end.

3. To facilitate and improve a one-stop integrated care centre

Many patients have indicated that they would prefer their care to be organised such that all their appointments can be carried out at the same place and within the same day. This would be much more convenient, especially for patients with movement disorders.

However, this would mean that since the different appointments will follow closely behind one another, a slight delay in any of the appointments will cause a chain effect and eventually lead to lengthy waiting times.

As such, to prevent the consultation from extending into the next time slot, we propose installing a ringer in every consultation room to remind both the patient and the doctor when the slot is over. This may be slightly rude and offensive to some patients, especially those who genuinely require the attention of the doctors. The vibrating wristband may a less invasive option.

Patients have also highlighted the fact that a full day of treatments may be extremely tiring for some and would rather the treatments be spaced out. This would render the one-stop integrated care centre less effective improving patients’ experience. Hence, to ensure that patients can fully utilise the one-stop integrated care centre, we propose the following:

• To create a restful environment in the waiting area for patients to allow them to take a break between appointments
• To have nurses on call to learn more about each patient’s condition or to answer any queries if they cannot be answered from the FAQ tab on the website. Nurses can do shifts, allowing patients to book 15 minutes slots when needed. A “press to call” ringer can be left at the counter for patients to use. As Parkinson’s disease often require the physical assessment of symptoms, this will be more beneficial to patients as compared to online platforms. This will also reduce the amount of time the doctor spends answering patients' queries, preventing further delays during consultation. However, older patients may still have the mindset that nurses are “less qualified” than doctors and may not trust the words of the nurses, thus reducing the efficiency of this system.
• Recreational activities can also be carried out (E.g. movie screening, arts and craft, etc.)

4. To provide patients with more information on their illness

While many patients have claimed that they are aware of the symptoms and health problems do look out for during their illness, many patients have also stated that they view well-explained treatments to be of utmost importance during their consultation.

To improve patient’s understanding of their treatment routine, comprehensive videos with subtitles and audios of different languages can be made available on hospital tablets which can be passed to patients after their consultation. This will allow them to have a better idea of how their treatment should be carried out and the things they should take note of during their treatment. These videos can also highlight reminders that Parkinson’s disease patients should commonly note, such as to exercise regularly, so that the patients are able to maintain a stable condition.

As Parkinson’s disease is a chronic illness, patients are bound to have many queries throughout their illness. Currently, most patients only visit the doctor every 6 months to 1 year and within this period of time, information about their illness is not readily accessible. Furthermore, the consultation time is very short, hence many patients and caregivers feel that they do not have enough time to ask the doctor their questions.

To ensure patients have maximum understanding of their illness, we propose exploring the use of virtual assistants (VA) and artificial intelligence (AI) technology on the official NNI website.

This will mean that patients will be able to access the information they need conveniently, whenever the want. Through the virtual assistants, patients are able to obtain quick and direct answers to their queries, reducing the need for call centres. They can also redirect patients to the relevant websites and improve patient experience overall.

5. To improve hospital environment

Patients have left comments on insufficient chairs, poor lighting and cluttered consultation room.

1. To improve the environment in the waiting area, we propose the following:
• Change all yellow lights to white lights
• Add more greenery
• Better colour coordination of walls (current colours: faded green and milky/off white)

• Soft and relaxing background music
• Resting area (library-like environment, no noise, conducive environment for patients to sleep/rest when waiting time is long)
• More spacious walkways, to facilitate smooth movement for patients in wheelchairs
• Increase number of chairs

6. To facilitate and improve community care project

Parkinson’s disease patients usually have a time interval of about 6-12 months before their next appointment. During this period of time, it may be possible that their condition deteriorates or that the medication becomes less effective. To ensure that the patients’ conditions remain stable, eligible patients can apply for community nurses to pay them house visits.

The same nurses will be seeing the same patients so that trust and rapport is built between the patients and the nurses.

Through this project, the nurses will be able to learn more about the patients’ condition on a day-to-day basis and with this information conveyed to the doctors, the patients’ treatment can be better planned to be more effective.

However, some patients feel that such a project will not be very helpful as some patients’ conditions are either stable without concern or already live in nursing homes with people to care for them. To ensure that efforts and resources are not wasted, we would like to propose the following:

• Proper assessment to be done such as to ensure that the patient needs help from the community
• Appointment timings be enforced with strict rules on both sides to prevent delays and inconvenience

7. To provide a one-stop resource centre for the convenience of the patients

To maximise the convenience for the patients, we propose that a PD app can be crafted to have the following functions for the patient’s easy access:

• Reminder system when the appointment date is drawing near
• Vibration system to remind the patient when it is time to enter consultation room
• QR code scanner to access tax invoice or have tax invoice directly available on the app
• Order form for medication
• Book a nurse for asking of queries
• Digital copies of information booklets on the condition
• Explanatory video and relevant episodes of TV shows
• Virtual assistant to answer Frequently Asked Questions or other predicted questions
• Links to relevant websites (information on condition, PD society, information on Medisave and Medishield etc.)

We hope that through the solutions we proposed, we would be able to make a changed to improve the efficiency of the current system and provide the Parkinson's disease patients as well caregivers with a more satisfactory experience.

3 content knowledge/skills learnt

1) Through this attachment, I managed to gain more knowledge on Parkinson’s disease and other neurological-related conditions and movement disorders.

Parkinson’s disease is a progressive neurodegenerative disorder that is caused by abnormal function in the area of the brain called the basal ganglia, which is important for coordinating movement. As a result of the progressive loss of brain cells in the substantia nigra, dopamine levels in the brain drop below normal levels. Dopamine, a neurotransmitter, is critical in allowing for the passing of electrical impulses between nerves. Simply, dopamine is involved in movement control, thus lack of dopamine can cause movement disorders, one of the symptoms of Parkinson’s disease. The cardinal symptoms of Parkinson’s disease include slowness of movement (bradykinesia), stiffness (rigidity), shaking of limbs when at rest (tremors) and stability problems when walking or standing (postural instability). Other non-motor symptoms begin to manifest as the condition worsens. Currently, there is no cure for Parkinson’s disease but effective treatments such as medication and therapy are available to control the symptoms and improve daily function.

Chorea is a movement disorder that results from basal ganglia injury due to a variety of causes. Chorea is characterised by sudden, brief involuntary muscle contractions causing movements that appear to flow from body part to body part in an unpredictable manner. This results in the patient having “dance-like” movements. Walking becomes a difficult task with odd postures and leg movements.

Essential tremor is usually a result of a genetic mutation that causes involuntary and rhythmic shaking. Essential tremor is not life threatening but symptoms may worsen over time, making it difficult to hold a cup without spilling, eat normally and write legibly. Essential tremor occurs most commonly in people aged 40 and above but may also occur during the teenage years.

2) Through our visit to the medical research lab, I have managed to gain more knowledge on medical research as well as on Drosophila flies.

Although I have participated in other research projects before, I have never done anything related to the field of medicine, so it was interesting to see and compare my experiences. There were similar equipment around the lab such as the micropipettes, centrifuge and autoclave machines. There were also new things which I have never seen such as shakers/rollers to constantly stir the mixture and different hoods for specific kinds of samples. I have always thought that research on animals is usually done on mice or monkeys, but flies which we usually regard as useless and annoying, can also be useful for research. There were also some places where the things we learnt in school came in handy as they introduced to us that they typically used liquid nitrogen or carbon dioxide to “knock out” the flies so that they can separate them into male and female or with bristles and without etc. The researchers there were also very friendly and shared with us that though the process of research is monotonous, it was the passion, curiosity and love for Science that kept them going and interested in what they do.

Prior to our visit to the lab, we researched on Drosophila flies -- what they were, why they were used and their purpose. So, we found that Drosophila flies are heavily used in research in genetics and is a common model organism in developmental biology. Furthermore, human and Drosophila fly genes are so similar that disease-producing genes in humans can be linked to those in the flies. Drosophila flies require little equipment to culture, can be readily anesthetized, are easily distinguished and have short generation times make it a popular choice as a model organism. Drosophila flies are attracted to yeast resulting from the initial decomposition of plant materials. They commonly attack and puncture the skin of overripe fruit and vegetables in order to lay eggs and feed. Thus, when we made fly food in the lab, we added dry yeast, some sugars and gelatin. Researchers avoid using overripe fruits as the food source as the flies may get stuck in the fruits and die.

3) One skill that I have managed to hone during this attachment was my observation skills. SGH is a very busy campus with many patients coming in for consultations and treatments and Clinic L is no exception. Many times, both Prof Tan and Ms Lim were busy with their work and had no time to give us specific instructions and we were left alone to be independent. This instead gave us the opportunity to hone our observation skills. During clinic observations, we had to observe how Prof Tan interacted with the patients, and picked out signs of unhappiness in the patient or concerns that they have. We also had to observe if the patient is uncomfortable with having us in the room and would prefer a more private conversation with the doctor. We had to look out if the patient makes comments like “Oh! There are so many people in the room!” or if they keep looking around the room and take our cue to leave to make the patient feel more at ease and comfortable. During data collection, our mentor was too busy and sometimes did not tell us if the patient had Parkinson’s disease or not. Thus, we had to see if the patient exhibited cardinal signs of Parkinson’s disease so as to not disturb the patients that are not of the target group. Of course, we had to observe everything else in our surroundings as there are many interesting and new things in the new environment. Other than observing our mentors, we also observed other people such as the medical students and nurses and also learnt things from them. For example, the eagerness of medical students to learn and to excel and to see what they learn in textbooks to finally be applied into real cases.

2 interesting aspects of your learning

1) Through this attachment, I have gained a better understanding of the job nature of a clinical research coordinator. They are involved in the recruiting of patients for their research projects, liasing with the researchers in the lab and also helping out Prof Tan during consultations. I found this interesting because I have never heard of such a position and neither did I know what their job scope was. The job of a clinical research coordinator is not easy, as they have to recruit the potential patients, explain the procedures to patients, collect the relevant samples and bring them to the respective labs. It requires many skills such as being familiar with the operation of the clinic, ability to communicate with the patients and tackle any arguments or unhappiness that arises. I thought that this job was equally as valuable as that of the doctor as they are the base that holds up the research of the condition. They facilitate the collection of samples and data for researchers and gather a large sample size to make the research process easier and more reliable. They too contribute a significant role to the betterment of the quality of healthcare provided.

2) Another interesting aspect was the interactions with the patients. Throughout our data collection process, the interviewees we interviewed were all very nice and some of them even engaged in small talk with us after the interview was over. I thought that it was nice to see them so happy but I was more interested by how they manage to stay so positive despite battling such conditions. Prof Tan as he always consoles the patient saying that their condition has not worsened much and the best way to tackle it is to be happy, be positive, worry less and the condition will eventually be stable or even improve. Everything boils down to the mindset of the patient. Only with a positive mindset and attitude, the patient is then more motivated to engage in activities and exercise which are great ways to manage Parkinson’s disease and delay the progression of the condition. In my opinion, this skill to make the patient believe in themselves is one of the most important skills that a doctor should have. Doctors need to balance how much information they give the patients in order to allow them to have enough information to care for themselves and understand the situation, but at the same time, not bombard them with information on the signs of the last stage of Parkinson’s disease and cause them to worry unnecessarily.

1 takeaway for life

One particularly important and precious lesson that I have learnt is that as medical professionals, we always have the interest of the patient placed first and I think that putting a smile on the patient’s face is the most important thing. As I am aspiring to work in a medical-related field, I think that seeing the smile on the patient’s face is the most satisfying and rewarding part of a medical-related job. Whether you are a doctor, researcher, nurse or clinic assistant, seeing the patient being positive and happy is, to me, the best gift. Of course, that only begins with a smile from you yourself. Since Parkinson’s disease is a chronic condition, many of the patients come back more than once for follow-ups. Many of the patients still recognize the clinical research coordinators and Prof Tan, hence they would engage in small talks. I thought that this was very interesting as it eases the patient, builds trust and rapport and makes them feel more at home. As for the clinical research coordinators and doctors, I feel that such small talks also act as small breaks for them to relax and make everyone’s day better.